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Standard Operating
Procedures
for Sterilization Services
in Camps
Family Planning Division
Ministry of Health and Family Welfare
Government of India
March 2008
Standard Operating Procedures
for Sterilization Services
in Camps
Family Planning Division
Ministry of Health and Family Welfare
Government of India
March 2008
2008
Ministry of Health & Family Welfare
Government of India, Nirman Bhawan, New Delhi - 110 011
Any part of this document may be reproduced and excerpts from it may be quoted without permission provided the material
is distributed free of cost and the source is acknowledged.
Printing of this edition for Government of India is supported by UNFPA, New Delhi
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Government of India
Ministry of Health & Family Welfare
Nirman Bhavan, New Delhi - 110011
G.C. Chaturvedi
Addl. Secretary & Mission Director
Foreword
In a country where the population has crossed the billion mark provision of assured quality Family
Planning services for the people becomes the priority of the policy makers. Sterilization is still the most
popular FP method adopted by our people to limit their family. As the demand for sterilization services
remains very high with a large unmet need the country has continued with the camp mode to reach the
services to people in under served and under reached areas. However, the camp approach throws out
challenges in terms of quality in service. Under the recently launched National Rural Health Mission
(NRHM) of Government of India the architectural changes envisaged would also address to these issues
by ensuring assured, fixed day quality services at FRUs, CHCs and 24x7 PHCs. However, we need to
continue with the camp mode for some more time till we achieve the NRHM goals.
As India is witnessing large changes in terms of development in the current era of globalization, the focus
is now shifting from mere provision of services to quality service provision. Ensuring quality services in
camps becomes one of the essential components in Family Planning service provision. The Government
of India has recently revised the Manuals on Female and Male Sterilization and Quality Assurance Manual
on Sterilisation, which form the standard guidelines for sterilization service for service providers. This
manual on Standard Operating Procedures (SOP) addresses important areas like planning for a camp,
logistics and manpower provision, infection prevention measures and monitoring quality of services
provided. The manual has been prepared with the expertise and insights received from State Program
officers, service providers, specialists like senior Obstetric & Gynecologists, Surgeons, Public Health
specialists. It is sincerely hoped that this manual would help in adhering with sterilisation standards in the
camps organized in many parts of the country.
The efforts put in by the Family Planning Division in preparing this maiden manual on SOP for Sterilisation
services and commitment to ensure quality services in Family Planning is truly commendable and is
deeply appreciated.
March 2008
Shri G.C. Chaturvedi
Addl. Secretary & Mission Director
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Dr. M.S. Jayalakshmi
Government of India
Ministry of Health & Family Welfare
Nirman Bhavan, New Delhi - 110011
Deputy Commissioner (FP)
Acknowledgement
This manual entitled “SOP for sterilization services in Camps” has been prepared as a supporting document
to the Standards on Female and Male Sterilisation and Quality Assurance Manual on Sterilizations, for
ensuring quality care in the Sterilisation camps. As the demand for sterilization services remains high and
still there are gaps in organizing fixed day service provision at sub district level in many States, dependence
on camps for catering to unmet need for limiting methods will have to continue for some more time.
This manual has been prepared based on the intensive inputs received from various service providers,
program managers and experts providing FP services in camps. It has been attempted to make the manual
practical under the existing service conditions, at the same time ensuring adherence to standards, hallmark
of service quality.
I wish to acknowledge the contribution of various experts who have helped the Family Planning division
in preparing the manual after extensive discussions and experience sharing. I singularly wish to appreciate
the continuous, untiring efforts and valuable inputs received from Dr Alok Banerjee, Dr. B. P. Singh,
Dr. Kaza and Dr. Mangal. A special word of appreciation for Dr. Dinesh Agarwal, National Programme
Officer, UNFPA for helping in the conceptualization of the manual. I am also thankful to all the State
officials whose experience in developing a system in quality care helped the expert group to prepare a
need-based manual. I also acknowledge the support rendered by WHO especially Dr Sonia Trikha in
facilitating all the meetings. The support extended by UNFPA in publication of this manual is sincerely
acknowledged.
The trust and support of Shri Amarjeet Sinha, Joint Secretary in all our endeavors to establish quality
care in Family Planning is deeply cherished by the division. My special thanks to Dr. Jaya Lalmohan and
Dr. Sonali, Consultants in Family Planning Division who have tirelessly worked for compiling this manual.
A special word of appreciation for Dr. S.K. Sikdar, AC (FP) whose contribution has been immeasurable.
I acknowledge the secretarial assistance rendered by Shri. Chauhan and Shri Malhotra from FP division
to bring out the manual in time.
It is hoped that this manual would encourage districts to ensure the highest quality of care in sterilization
service provision.
March 2008
Dr. M.S. Jayalakshmi
Deputy Commissioner (FP)
Introduction and the scope of the manual....................................................................................... 1
1. Range of services in a camp ......................................................................................................3
1. Counselling ............................................................................................................................3
2. Clinical Services ......................................................................................................................3
3. Lab Tests ...............................................................................................................................4
2. Pre-requisites for sterilization camps ...................................................................................... 5
1. Site ........................................................................................................................................5
2. Probable Client Load ...............................................................................................................5
3. Camp Timings ........................................................................................................................5
4. Staff .......................................................................................................................................6
5. Equipment/Instruments and Supplies ......................................................................................7
3. Roles and responsibilities of programme managers and service providers ...........................9
I.
Pre-camp Activities (beginning of the year) ............................................................................. 9
II. During Camp ........................................................................................................................10
4. Conduction of camps ...............................................................................................................15
1. Pre-camp Activities ...............................................................................................................15
2. Camp Activities .....................................................................................................................15
3. Post-camp Activities ..............................................................................................................17
5. Prevention of infection: asepsis and antisepsis .....................................................................19
1. Maintenance of Asepsis in OT ................................................................................................19
2. Processing of Equipment, Instruments and other Reusable Items .............................................20
3. Sterilization or High-Level Disinfections (HLD) .......................................................................21
4. Disposal of Waste, Needles, and Other Materials ....................................................................23
6. Assurance of quality in camp setting ......................................................................................25
7. Annexures .................................................................................................................................27
Annexure 1: Equipment for Male/Female Sterilization: ...........................................................29
Annexure 2: Management of Emergencies in Sterilization Services ........................................34
Annexure 3: Common Emergency Drugs .................................................................................38
8. List of experts for formulating the Standard Operating Procedures on
Family Planning Services ............................................................................................................40
ANM
Auxiliary Nurse Midwife
BCC
Behaviour Change Communication
CHC
Community Health Centre
CMO
Chief Medical Officer
FRU
First Referral Unit
HLD
High Level Disinfection
IEC
Information Education Communication
IP
Infection Prevention
IUCD
Intrauterine Contraceptive Device
LHV
Lady Health Visitor
MO
Medical Officer
MPW
Multipurpose Worker
MSMF
Manual on Standards for Male and Female Sterilization, GOI-2007
NFHS
National Family Health Survey
NRHM
National Rural Health Mission
NSV
No Scalpel Vasectomy
OCP
Oral Contraceptive Pills
OT
Operation Theatre
PHC
Primary Health Center
QAC
Quality Assurance Committee
RCH
Reproductive Child Health
RTI
Reproductive Tract Infection
STI
Sexually Transmitted Infection
Introduction
The recent NFHS III (2005-2006) results show that the total unmet need in contraception for the
country still remains high at 13%, out of which 6% is for permanent methods and 7% is for spacing
methods. Traditionally the country has been adopting the camp approach in sterilization since the early
‘70s to address the issue of large need versus low service availability. Under the NRHM and RCH II
programmes of Government of India many strategies are being operationalized to reduce the unmet
need in RCH services including contraception. However, we need to continue with the camp approach
for some more years until adequate institutionalized services are made available as per the needs of
the people at the most peripheral level. Though this approach has the advantage and flexibility of
reaching the needy at their doorsteps, quality of care becomes an area of concern in such settings.
Hence it becomes essential to have guidelines developed for ensuring quality care in camps, addressing
to the large demand in difficult to reach/underserved areas which are not usually endowed with
routine services.
Camps are an alternate service delivery strategy aiming for meeting unmet demand for sterilization
services especially in underserved areas. Clearly there are challenges in ensuring adherence with the
standards in the camp setting. Present document addresses these barriers by spelling out operating
procedures and thus empowers service providers and camp managers to deliver quality services under
all circumstances.
The formulation of Standard Operating Procedures (SOPs) for Sterilization Camps is an important
step in ensuring provision of quality services to the growing number of clients coming for sterilization
services in the out reach camps. It is envisaged that programme managers and service providers would
be encouraged to take appropriate remedial measures for ensuring adherence to standards in the camps
as laid down in the “Manual on Standards for male and female sterilization” by Government of India.
The scope of the manual
The Standard Operating Procedures would serve as a guide for planning, implementing and monitoring
quality of services in sterilization in a camp setting, for programme managers, camp managers and service
providers at all levels. This document may also be found useful by the service delivery organisations
engaged in organisation of the camps, including NGOs.
1.Range of services in a camp
What is a “camp”?
A sterilization camp is defined as alternate service delivery mechanism, when “operating team located
at a remote facility (District HQs/Medical colleges/FRUs) conducts sterilization operations at a sub
district health facility, where these services are not routinely available.”
Service package for camp services should include following:
1. Counselling
Counselling is the process of helping clients make informed and voluntary decisions about their
fertility. Method specific counselling should be done whenever a client is unable to take a decision
or has a doubt regarding the type of contraceptive method to be used. In the case of clients found
eligible for sterilization the following steps should be taken before she/he signs the consent form for
sterilization:
 Clients must be informed of all the available methods of family planning and should be made
 Clients must make an informed decision for sterilization voluntarily.
 Clients must be counseled in the language that they clearly understand.
 Clients should be made to understand what will happen before, during, and after the surgery,
aware that for all practical purposes, sterilization is a permanent one.
its side effects, and potential complications, including failure
In situations where the camp is providing other FP methods, method specific counseling should also
be provided
2. Clinical Services
(a) Permanent methods
Vasectomy
and/or
Tubectomy
t
t
t
t
t
Screening and clinical assessment
Pre-procedure instructions/preparation
Procedure
Post-operative examination & instructions
Follow-up
Standard Operating Procedures for Sterilization Services in Camps
4
Depending upon the availability of human resources, service availability at the camp sites, the district
programme managers can decide the type of additional services to be offered in Sterilization Camps
as given below.
Additional Services
(b) Spacing methods
IUCD
t
t
Combined Oral Pills
Condoms
t
t
t
t
t
t
t
t
t
t
Counselling
Screening and clinical assessment
Insertion
Follow-up
Management of complications
Removal
Counselling
Eligibility assessment
Provision
Counselling
Provision
Instructions for proper use
(c) Emergency contraception
t Counselling
t Eligibility assessment
t Provision
(d) Screening and management of RTIs/STIs
t Diagnosis and management as per national guidelines
3. Lab Tests
t
Hb
t Urine for sugar and albumin
t Urine for Pregnancy Test (as indicated in Standards of Male and
Female Sterilization)
t In case of RTI/STI lab tests as per GOI Guidelines
2.Pre-requisites for sterilization camps
The camp should be organized exclusively for sterilization services. Additional services can also be
offered depending on the existing service provision for additional services.
1. Site
All Sterilization Camps must be organized only at established health care facilities as laid down in the
Standards by GOI.
For IUCD insertion, a clean separate room with adequate lighting arrangement and privacy will be
sufficient.
Oral Pills, Emergency Contraceptive Pills and Condoms can be dispensed at the counselling area.
Under no circumstances should Sterilization Camps be organized in a school building/Panchayat
Bhavan or any other such set up. Camps should be always organised either at CHCs or PHCs.
2. Probable Client Load
Estimation of likely number of clients to turn up for accessing services will help in determining number
of teams. For maintaining quality service, each surgeon should restrict to conducting a maximum of:
 30 laparoscopic tubectomy (for 1 team with 3 laparoscopes) or
 30 vasectomy (NSV or conventional) or
 30 minilap tubectomy cases.
* With additional surgeons, support staff, instruments, equipment and supplies, the number of
procedures per team may increase proportionately. However, the maximum number of procedures
that are performed by a team in a day should not exceed 50.
Depending upon the expected client load, requisite number of teams should be mobilized by the
camp manager.
3. Camp Timings
Camp timings should preferably be between 9 a.m. and 4 p.m.
6
Standard Operating Procedures for Sterilization Services in Camps
4. Staff
A. For Female Sterilization
(a) Local team
Serial
No.
Camp Service Site/Counter
Total No.
of Staff
Category and No. of Staff
1.
Registration
1
Male worker/clerk – 1
2.
History & Clinical Assessment
2
MO – 1
Staff Nurse/LHV/ANM – 1
3.
Counselling Area
1
Health supervisor/ANM – 1
4.
Laboratory Examination
2
Lab Technician – 1
Cleaner – 1
5.
Pre-operative Preparation/
Premedication preparation room
1
Staff Nurse/LHV/ANM – 1
6.
Instrument & reusable items
processing/sterilization area IP Room
2
OT Attendant – 1
Ward Boy/Aya – 1
7.
Operation theatre
3
8.
Post-operative room
2
9.
Office-cum-store
2
10.
IUCD/Other procedure room
2
Staff Nurse/ANM – 1 (either from the site area or if not there at the site, then to come with the
visiting team)
OT Attendant – 1
Cleaner – 1
MO – 1
Staff Nurse/ANM – 1
Accountant – 1
Compounder/Pharmacist – 1
ANM– 2
(b) Visiting team members
Serial
No.
Staff Category
No. of Staff for Tubectomy
Laparoscopy
Minilap
1.
Empanelled tubectomy surgeon
1
1
2.
Anaesthetist (preferable)
1
1
3.
OT Assistant
1
-
Standard Operating Procedures for Sterilization Services in Camps
B.
7
For Male Sterilization
(a) Local team
Serial
No.
Camp Service Site/Counter
Total No.
of Staff
Category and No. of Staff
1.
Registration
1
Health worker (M)/clerk – 1
2.
Clinical Assessment
2
MO – 1, Male worker – 1
3.
Counselling Area
1
Male Supervisor/Male worker – 1
4.
Laboratory Examination
2
Lab Technician – 1
Cleaner – 1
5.
Pre-operative Preparation Room
1
Health worker-male – 1
6.
7.
Instrument & reusable items
processing/sterilization area
Operation theatre
2
2
8.
Post-operative room
2
9.
Office-cum-store
2
OT Attendant – 1
Ward Boy/Aya – 1
Staff Nurse/ANM – 1
Cleaner – 1
MO – 1
Staff Nurse/ANM – 1
Accountant – 1
Pharmacist – 1
(b) Visiting team members
Serial
No.
1.
Staff Category
Empanelled Surgeon
No. of Staff for Vasectomy
1
The responsibility of provision of the additional services is to be borne by the local team as per the
guidelines laid down by Government of India.
5. Equipment/Instruments and Supplies
The Equipment/Instruments and supplies needed for ensuring quality services in sterilization camps,
is given in Annexure 1.
In camps where other services are offered, additional supplies for those services also need to be made
available.
The In-Charge of the facility where the camp is being organised is the CAMP MANAGER who has
the overall responsibility for the effective organisation of the camp.
2.Pre-requisites for sterilization camps
The camp should be organized exclusively for sterilization services. Additional services can also be
offered depending on the existing service provision for additional services.
1. Site
All Sterilization Camps must be organized only at established health care facilities as laid down in the
Standards by GOI.
For IUCD insertion, a clean separate room with adequate lighting arrangement and privacy will be
sufficient.
Oral Pills, Emergency Contraceptive Pills and Condoms can be dispensed at the counselling area.
Under no circumstances should Sterilization Camps be organized in a school building/Panchayat
Bhavan or any other such set up. Camps should be always organised either at CHCs or PHCs.
2. Probable Client Load
Estimation of likely number of clients to turn up for accessing services will help in determining number
of teams. For maintaining quality service, each surgeon should restrict to conducting a maximum of:
 30 laparoscopic tubectomy (for 1 team with 3 laparoscopes) or
 30 vasectomy (NSV or conventional) or
 30 minilap tubectomy cases.
* With additional surgeons, support staff, instruments, equipment and supplies, the number of
procedures per team may increase proportionately. However, the maximum number of procedures
that are performed by a team in a day should not exceed 50.
Depending upon the expected client load, requisite number of teams should be mobilized by the
camp manager.
3. Camp Timings
Camp timings should preferably be between 9 a.m. and 4 p.m.
Standard Operating Procedures for Sterilization Services in Camps
4. Staff
A. For Female Sterilization
(a) Local team
Serial
No.
Camp Service Site/Counter
Total No.
of Staff
Category and No. of Staff
1.
Registration
1
Male worker/clerk – 1
2.
History & Clinical Assessment
2
MO – 1
Staff Nurse/LHV/ANM – 1
3.
Counselling Area
1
Health supervisor/ANM – 1
4.
Laboratory Examination
2
Lab Technician – 1
Cleaner – 1
5.
Pre-operative Preparation/
Premedication preparation room
1
Staff Nurse/LHV/ANM – 1
6.
Instrument & reusable items
processing/sterilization area IP Room
2
OT Attendant – 1
Ward Boy/Aya – 1
7.
Operation theatre
3
8.
Post-operative room
2
9.
Office-cum-store
2
10.
IUCD/Other procedure room
2
Staff Nurse/ANM – 1 (either from the site area or if not there at the site, then to come with the
visiting team)
OT Attendant – 1
Cleaner – 1
MO – 1
Staff Nurse/ANM – 1
Accountant – 1
Compounder/Pharmacist – 1
ANM– 2
(b) Visiting team members
Serial
No.
Staff Category
No. of Staff for Tubectomy
Laparoscopy
Minilap
1.
Empanelled tubectomy surgeon
1
1
2.
Anaesthetist (preferable)
1
1
3.
OT Assistant
1
-
Standard Operating Procedures for Sterilization Services in Camps
B.
For Male Sterilization
(a) Local team
Serial
No.
Camp Service Site/Counter
Total No.
of Staff
Category and No. of Staff
1.
Registration
1
Health worker (M)/clerk – 1
2.
Clinical Assessment
2
MO – 1, Male worker – 1
3.
Counselling Area
1
Male Supervisor/Male worker – 1
4.
Laboratory Examination
2
Lab Technician – 1
Cleaner – 1
5.
Pre-operative Preparation Room
1
Health worker-male – 1
6.
7.
Instrument & reusable items
processing/sterilization area
Operation theatre
2
2
8.
Post-operative room
2
9.
Office-cum-store
2
OT Attendant – 1
Ward Boy/Aya – 1
Staff Nurse/ANM – 1
Cleaner – 1
MO – 1
Staff Nurse/ANM – 1
Accountant – 1
Pharmacist – 1
(b) Visiting team members
Serial
No.
1.
Staff Category
Empanelled Surgeon
No. of Staff for Vasectomy
1
The responsibility of provision of the additional services is to be borne by the local team as per the
guidelines laid down by Government of India.
5. Equipment/Instruments and Supplies
The Equipment/Instruments and supplies needed for ensuring quality services in sterilization camps,
is given in Annexure 1.
In camps where other services are offered, additional supplies for those services also need to be made
available.
The In-Charge of the facility where the camp is being organised is the CAMP MANAGER who has
the overall responsibility for the effective organisation of the camp.
3.Roles and responsibilities of programme
managers and service providers
All functionaries in a camp must work together as a team towards successful and smooth conduction
of the camp. The roles and responsibilities given here are only suggestive and they can be interchanged
as per need/requirement of a particular situation.
The organization of a camp has 2 stages1. Planning for the camp
2. Conduction of the camp
This chapter specifies the roles and responsibilities of officials for both the stages.
I.
Pre-camp Activities (beginning of the year)
A. District chief medical officer
 To update the list of empanelled surgeons and circulate to all camp managers
 To notify/designate camp managers at the facilities likely to organize sterilization camps during
 To organize availability of funds from RCH 2 programme at the facility level
 To constitute teams for camps in consultation with I/C District hospital/ FRUs from where
B.
District nodal officer for FP (ADHO, Dy CMHO, DPM or others)
 Develop block-wise quarterly camp calendar specifying date and site in consultation with
the year
the providers are going to be sent to camps.
camp in-charge
t
To ensure communication to the operating teams in advance
t
To keep ready a list of standby staff so as to meet any contingency requirements
t
To keep a stock of equipment such as laparoscopes/NSV equipment ready and also
arrange for AMC/repairs
t
To ensure that all necessary supplies required for the camps are made available in
adequate quantities before the commencement of the camp
t
To ensure that adequate funds are available with the camp manager for disbursement as
incentives.
10
Standard Operating Procedures for Sterilization Services in Camps
C.
Camp manager/sub-district hospital/FRU/CHC/PHC (camp site)
 To coordinate the team activities with the district nodal officer
 To arrange for the required funds for organizing the camps
 To ensure availability of the local team members
 To ensure availability of equipment, instruments and other supplies for each camp
 To ensure intense IEC activities regarding the camp in his area in coordination with the District
authorities.
II. During Camp
For the delivery of services in the camps, two teams are required to work in close coordination, i.e. the
local team at the camp site and the visiting team.
Local Team
Camp manager
The responsibilities of the Camp Manager are:
 To ensure all members of visiting team reach in time
 To assign responsibilities for the facility staff for staffing different stations
 To check that OT has been disinfected in advance
 To ensure that emergency medicines and other supplies are available at designated places
Site medical officer
 To ensure that all clients are counselled properly
 To conduct full clinical assessment of the clients and document the same as specified in the
 To provide pre-procedure instructions to clients (MSMF, pg 54-58)
 To provide post-procedure check-up and give instructions, both verbal and written before
 To take care of post-procedure follow-up of clients for any problem inclusive of stitch
 To counsel and provide other contraceptive services to clients found not eligible for
GOIs Standards manual.
discharge for each operated client (MSMFl pg 62,63,69,70)
removal for sterilization clients.
sterilization.
Staff nurse/ANM
She will be overall in-charge of preparation and maintenance of Operation Theatre (OT) complex and
infection prevention measures.
 To provide counselling for all the clients coming for sterilization
Standard Operating Procedures for Sterilization Services in Camps
11
 To assist MO in performing pre-procedure clinical assessment.
 To ensure documentation of written informed consent
 To ensure sufficient material including sterilized linen, instruments and other supplies
 To ensure proper IP practices at all levels ,before and during all procedures
 To ensure that all the emergency equipment is in functional order and available
 To confirm the pre-procedure check-up of clients by empanelled surgeon/gynaecologist and
 To assist empanelled surgeon/gynaecologist and anaesthetist during procedures
 To monitor the clients during the procedure and assist in post-operative care
anaesthetist and ensure completion of records before the procedure
Laboratory technician
 To ensure availability of all the laboratory equipment and reagents for the camp
 To perform pre-procedure investigations like Hb, urine, etc.
 To document the findings of investigations on the client’s chart
 To maintain the record of all investigations done
 To ensure quality of all laboratory investigations
Pharmacist
 To ensure sufficient medicines and other supplies for all the clients
 To distribute medicines to the clients as per guidance of medical officers/surgical team
 To perform any other duty assigned by the camp manager
Health supervisor/worker
 To assist in filling up charts and consent forms of clients
 To give pre- and post-procedure instructions to clients/attendants
 To guide the clients for different services
 In the absence of a Staff Nurse, should perform her duties
 To be in charge of the registration counter
 To perform any other duty assigned by the camp manager
Class IV (OT attendant/ward boy/ayah, etc.)
 To prepare facility for the camp under guidance of supervisors
 To shift clients to and from OT
 To carry equipment/articles from and to the vehicle
 To assist OT Assistant and staff nurse in OT
12
Standard Operating Procedures for Sterilization Services in Camps
 To decontaminate articles
 To clean instruments and linen
 To perform any other job assigned by the camp manager
Safai karmchari
 To clean the premises including lab, procedure room and OT
 To trim hair in vasectomy clients
 To disinfect procedure room and OT under guidance of OT Staff
 To help the other Class IV workers to shift equipment and linen from one place to another and
 To perform any other job assigned by the camp manager
also to shift the clients, if necessary
Visiting Team
Surgeon/gynaecologist
 To ensure that each client has been adequately counselled and screened as per laid down
 To fill the checklist before conducting the procedure
 To ensure requisite equipment/instruments and supplies for the procedure as well as those
 To perform sterilizations of screened clients as per the laid down procedures
 To ensure emergency and surgical procedure preparedness
 To practice and ensure adherence to universal IP practices in all procedures
 To document procedural details and post-operative instructions on the records of all operated
 To do post-operative check-up wherever required as per Standards.
 To deal with emergencies and ensure appropriate referral to higher centre in case of complications
Standards in the prescribed format including ensuring/confirming pre-procedure fitness and
informed consent of client for the procedure
needed for emergency preparedness are as per the Standards.
cases as given in the Standards
Anaesthetist (if available)
 To verify the availability and functionality of anaesthetic instruments and drugs at the
 To ensure pre-operative check-up and fitness for anaesthesia whenever required.
 To supervise local and administer regional or general anaesthesia according to the situation
 To deal with any emergency/complication related to procedures
camp site
Standard Operating Procedures for Sterilization Services in Camps
 To document anaesthesia notes in the chart of each client
 To do immediate post-operative follow-up of cases operated under anesthesia
13
Operation theatre assistant (OTA)
 To work in coordination with staff nurse/ANM/LHV
 To verify the availability of all the equipment and instruments and ensure that they are in func-
 To ensure HLD/sterilization of equipment, instruments, linen, etc.
 To ensure cleanliness and disinfection of OT
 In case of female sterilization, to make sure that the laparoscopes are processed after each
 To assist the empanelled surgeon and anaesthetist during procedures
 To perform any other job assigned by the visiting team
tional condition in the operation theatre
procedure and at the end of the camp session, as laid down in the Standards.
4.Conduction of camp
In the following paragraphs, an attempt has been made to list different activities which are critical to deliver quality
services in a camp setting.
1. Pre-camp Activities
1.1 Communication Activities
i.
Inform ANMs, ASHAs, AWWs, VHSC members in advance during monthly meetings about
the camp dates and venue
ii. Organise wall paintings at busy sites i.e. bus stands, display banners
iii. Use local cable TV network if possible
1.2 Planning for the Camp
 Orientation of site staff on previous day by camp manager
 Review of infrastructure and availability of equipment and supplies including case sheets,
 Mobilization of staff from periphery/additional PHC/other sites if required
 Preparation of duty list and intimation of the staff
 Ensuring electricity and running water supplies
 Ensuring availability of compensation money
 Confirming availability of surgical team at scheduled time
 Ensuring availability of transport facility for referrals
 Putting up display boards in health institutions, one month prior to the camp, which shall
 Providing adequate sitting and waiting arrangements with protected space (from sun and rain)
 Making adequate arrangements for drinking water, sanitation and toilet facilities for the health
consent forms, follow up cards, etc.
intimate the date of camp with time and services to be provided on that day
provided for both clients and attendants.
personnel as well as the clients and their attendants. One toilet should be earmarked for
women
2. Camp Activities
 Primary responsibility for organizing the camp lies with the designated camp manager
16
Standard Operating Procedures for Sterilization Services in Camps
 All instruments, drugs and supplies for the camps should be made available in advance and put
 Site facility should ensure enough sterilized linen and other material including stationery and
 The normal functioning of the CHC/PHC should not be disrupted.
 Adequate safety arrangements in coordination with the local police authorities should also be
 There should be clear signages for the different service areas as specified below to facilitate the
in their right places.
forms as per expected client load.
provided for, to prevent any untoward incidents If large number of client s are expected
smooth flow of clients.
GENERAL AREAS:
t
Waiting area
t
Registration area
t
Counselling Area
t
Clinical Examination
t
Laboratory Examination
t
Office-cum-store
PROCEDURE AREAS:
t
Pre-procedure preparation area
t
Instrument processing area
t
Scrub area
t
Operation theatre - if both tubectomy and vasectomy services are provided, there
should be separate operation theatres
t
Post-operative or recovery room/ward
Standard Operating Procedures for Sterilization Services in Camps
17
Flow Chart for Camp Services
Registration
Counselling
Clinical Assessment for Clients Agreeable for Sterilization
Fit for Sterilization
Informed Written
Consent
Lab Tests
Unfit for Sterilization
RTI/STI
Spacing Methods
Counselling
Management
and Counselling
Pre-procedure Assessment
Surgical Procedures
Method Provision
If Services Not
Available, Refer
Post-operative Care
IUCD
Other
Spacing
Methods
Post-procedure
Counselling
Post-procedure Counselling
and Medications
3. Post-camp Activities
 Provide follow-up care as laid down in the Standards Manual
 Attend to complications of procedures, if any, that were performed in the camp (Refer to
Standards for Female and Male Sterilization)
All staff of the health care facility should preferably be trained in emergency
management.
Guidelines for emergency management should be followed as given in Annexure 2
5.Prevention of infection:
asepsis and antisepsis
It is mandatory to practice appropriate infection prevention (IP) procedures at all times with all clients
to decrease the risk of transmission of infection, including the Human Immunodeficiency virus (HIV),
Hepatitis C (HCV), and Hepatitis B (HBV). Standard universal precautions of infection prevention
include:
 Washing hands
 Ensuring self-protection by wearing attires, gloves and employing other physical barriers
 Adopting safe work practices (to prevent injuries from sharp instruments)
 Maintaining proper methods of environmental cleanliness
 Ensuring the proper processing of instruments and other items
 Following proper waste-disposal practices and handling, transporting, and processing used
and/or soiled linen in the recommended and prescribed manner.
Detailed guidelines for IP practices are given in the Standards for Male and Female Sterilization.
However, some of the important steps are highlighted in this chapter.
1. Maintenance of Asepsis in OT
Before Surgery
 Clean the floor with a mop soaked in 0.5% chlorine solution.
 Clean the table/counter top with a cloth soaked in 0.5% chlorine solution
After Surgery
 Decontaminate all operating room surfaces that come into contact with the patient (such as
 The operating table, counters/table tops and light handles should be wiped with a detergent
 Chlorine solution should be prepared fresh daily
table) between procedures by scrubbing and wiping them with 0.5% chlorine solution
and 0.5% chlorine solution
When Not in Use
 The OT should be locked when not in use
 Daily cleaning: Scrub and wipe the room with the recommended disinfectant i.e. 0.5% chlorine
solution
20
Standard Operating Procedures for Sterilization Services in Camps
Movement in and around the OT
 The entry of people and their movement inside the OT should be minimal as the introduction of
 During surgery, the door of the OT should be kept closed
 Only the personnel performing or assisting should enter the OT
 Personnel who have any infection should not enter the OT at all
a number of micro-organisms is related directly to the number of people and their movement
Recovery Room (RR)
 The entry of people and their movement inside the RR should be minimal as the introduction of
 During post-operative care the door of the RR should be kept closed
 Only the personnel involved in post-operative care like the attending surgeon/anaesthetist
 Personnel who have any infection should not enter the RR at all
 Only one relative should be allowed
a number of microorganisms is related directly to the number of people and their movement
should enter
2. Processing of Equipment, Instruments and Other Reusable Items
Steps involved are:
1.
Decontamination of Equipment, Instruments, and Other Reusable Items
 Surgical instruments, reusable gloves, and other items that have been in contact with blood or
 Immediately after use, these items should be placed in a plastic bucket containing a solution of
 After 10 minutes, the items should be removed from the chlorine solution and rinsed with
 Utility gloves and clothes should be worn during this and subsequent steps
 A new chlorine solution should be prepared at the beginning of each day
2.
Cleaning of Equipment, Instruments, and Other Reusable Items
 Cleaning reduces the number of micro-organisms and endospores on instruments and
 The instruments and other items should be scrubbed vigorously with a brush (a tooth brush
 Detergent should be used as water alone will not remove proteins or oil
other body fluids should be decontaminated prior to cleaning
0.5% chlorine for 10 minutes
water or cleaned immediately
equipment
is a good option) in lukewarm water with detergent to remove all blood, tissue, and other
residue
Standard Operating Procedures for Sterilization Services in Camps
21
 Soap is not recommended as it can leave a residue
 Hot water should not be used because it can coagulate protein such as blood, making it harder
 The items should then be rinsed thoroughly with water and allowed to air-dry. Items that
to remove
require HLD by boiling can be placed directly in a pot of water after cleaning
Preparation of 0.5% Chlorine Solution
Mix 150 gm of commercially available bleaching powder (about 10 tablespoonful/30 teaspoonful)
in ten litres of tap water. Before mixing, make a paste in small quantity of pre-measured water and
mix into the remaining measured water. The prepared chlorine solution can be used for 24 hours.
Prepare fresh chlorine solution at the beginning of camp.
3. Sterilization or High-Level Disinfections (HLD)
HLD by Boiling
Instruments for HLD must be decontaminated and cleaned with detergent and water prior to
 Once the water starts boiling, boil for 20 minutes in a pot with a lid. Articles must be com-
 Do not add anything to the pot after boiling begins
 After boiling, remove objects with a sterile or previously HLD forceps
 Use objects immediately or store them in a covered, airtight, dry HLD container for up to
 If stored in an ordinary covered container, the objects can be used for up to 24 hours
boiling
pletely immersed in the water
seven days
HLD by Chemical Method
 After decontaminating, cleaning, and drying the used objects, soak for 20 minutes in a solution
 Thoroughly rinse the objects with water boiled for 20 minutes before use
 Use objects immediately or place them in a covered, dry HLD container
 Items should never be kept soaked in water or solutions such as Cetavalone, spirit, carbolic
containing 2% glutaraldehyde.
acid, glutareldehyde, etc. Always store HLD items dry.
Steam Sterilization (Autoclaving)
 Always consult the specific operating instructions supplied by the manufacturer
 Decontaminate, clean, and dry all instruments that are allowed to be autoclaved
22
Standard Operating Procedures for Sterilization Services in Camps
 Wrap cleaned instruments in cloth or newspaper, or place unwrapped instruments in a metal
 Arrange wrapped packs in the chamber or drum to allow free circulation of heat or steam
 Items such as scissors and forceps should be sterilized in an open position
 Sterilize instruments for the recommended time as shown below:
container
among the surfaces of all items.
** Sterile water can be prepared by autoclaving at 15 lbs. pressure
Time necessary to autoclave liquids like water depends on many factors and the most important of
which is the volume of water being autoclaved. In general timings are:





75-100 ml
100-500 ml
500-1000 ml
1000-1500 ml 1500-2000 ml –
–
–
–
–
20 minutes
25 minutes
30 minutes
35 minutes
40 minutes
Sterilization by Chemical Method
 Decontaminated, cleaned, and dried items are put in 2% glutaraldehyde solution for at least 8
 Items such as scissors and forceps should be put into the solution in an open position.
 Do not add or remove any items once the timer starts.
 Items should be rinsed well with sterile water** (not boiled water), air-dried, and stored in a
 This method is most suitable for endoscopes and plastic cannulae.
to 10 hours.
covered sterile container for up to 7 days.
Processing Laparoscopes
 Laparoscopes and accessories should be sterilized or should undergo HLD using the chemical
 Decontamination: Immediately after use, gently wipe the laparoscope, fibrotic light source,
 Cleaning: Place the dissembled parts of the laparoscope in a basin of clean water. Wash all
method by soaking in 2% glutaraldehyde solution. All steps of the decontamination and cleaning process must be followed before the laparoscopes and accessories are put in the chemical
solution.
and cable and plastic tubing with lure lock using a cloth soaked in 60–90% ethyl or isopropyl
alcohol to remove all blood and organic material.
outer surfaces using a soft cloth. Clean the inner channels with a clean brush supplied with the
laparoscopic kit. Dry with clean soft cloth.
Standard Operating Procedures for Sterilization Services in Camps
23
 High-level disinfection: Put clean and dried dissembled equipment in a basin containing
 Sterilization: To sterilize, soak the clean and dried dissembled laparoscope in 2% glutaral-
2% glutaraldehyde solution for 20 minutes. For the disinfection to be effective, all parts of the
laparoscope must be fully immersed and the disinfectant must touch all the surfaces of the
instrument. Rinse twice with HlD water (water boiled for 20 minutes and cooled) to remove all
traces of the disinfectant.
dehyde solution for 8 to 10 hours. Rinse a least three times with sterile water to completely
remove all traces of the disinfectant and store in a sterile covered container.
4. Disposal of Waste, Needles, and Other Materials
 Contaminated waste is a potential source of infection for the staff as well as the local com-
 Waste should be buried or burnt. Burning should preferably be done in an incinerator or steel
 If burning is not possible, then the waste should be put in a pit and buried, but it should never
 For waste that is to be picked by the municipal authorities, these should be placed in closed
 Solid waste, including dressings and other items contaminated with blood and organic mate-
 Liquid waste should be poured down a utility drain or into a toilet or latrine with a flush; or else
 Sharp objects (hypodermic needles, scalpel blades, suture needles) should be disposed of in
 Containers with needles and sharp objects should be disposed of by burning or burying
munity. Therefore, waste should be disposed of properly.
drum as opposed to open burning.
be thrown outside or left in open pits.
dumpsters prior to removal.
rial, should be disposed of in leak-proof washable containers conveniently located in the OT/
procedure house.
it should be buried. Avoid splashing when disposing of liquid waste.
a puncture-resistant container with a lid made of either metal or heavy rigid plastic or cardboard.
on site.
24
Standard Operating Procedures for Sterilization Services in Camps
Summary of Methods of Sterilization and High-Level Disinfection for
Various Reusable Materials
Materials
Method
HLD
Sterilization
Linen (Drapes, sponges,
scrub suits, operating
packs, etc.)
Not recommended
Autoclaving: 121° C at 15 lb./sq. inch pressure for 30
minutes. Should be used within one week. If drum is
opened, then use within 24 hours.
Rubber goods (gloves,
catheters, and rubber
tubing) and Surgical
Instruments
By boiling:
20 minutes
By autoclaving:
At 15 lb./sq. inch pressure for 30 minutes Always wrap
items in paper/newspaper before autoclaving.
Gloves should always be sterilized for 30 minutes at 15
lb./sq inch pressure by wrapping in paper/newspaper and
should be used 24 – 48 hours after sterilization so that they
regain their elasticity
By immersing in
chemical:
a. Glutaraldehyde –
20 minutes
or
b. Parasitic acid –
10 minutes
By immersing in chemical:
a. Glutaraldehyde – 10 hours
or
b. Parasitic acid – 30 minutes
6.Assurance of quality in camp setting
The quality of sterilization services provided can be assessed through the already existing documentation
tools available at the facilities and instrument/tools specifically designed for this purpose. The areas
requiring improvement should be identified using these tools and this will ultimately be beneficial in
improving the quality of the services delivered.
The following need to be monitored for assuring quality care in a camp:
 Facility inputs
 Procedures adopted
 Maintenance of records and registers
 Client care and satisfaction
The District Quality Assurance Committee (DQAC) as well as the Quality Improvement Committee
(QIC) at the facility level are responsible for monitoring quality.
Role of DQAC
The DQAC should monitor at least 10% of the camps held in the district to ensure quality of care as
per the checklists for Client case record, Facility Audit, Observation of Asepsis and surgical procedure,
and Client Exit interview laid down in the “Quality Assurance Manual for Sterilization Services“ by
Government of India.
Role of Quality Improvement Committee
At each service delivery site sterilization service needs to be monitored and reviewed.
This task can be performed by service providers from the facility itself through a process of selfassessment that will identify issues related to quality improvement, help in resolving the identified
problems, recommend solutions, and ensure that high-quality services are provided.
The suggested composition of the QIC at District Hospitals/Civil Hospitals/Sub-divisions/Referral
Hospitals is as follows:
 I/C Hospital/Medical Superintendent: Chairperson
 I/C Operation Theatre/Anaesthesia I/C, Surgeon
 I/C Obstetrics and Gynaecology
 I/C Nursing
 I/C Ancillary Services (ward boys)
26
Standard Operating Procedures for Sterilization Services in Camps
 I/C Transport
 I/C Stores
 I/C Records
At the level of CHC, a smaller committee of 4 to 5 members comprising the Medical Superintendent,
I/C Surgery, I/C Obstetrics and Gynaecology, I/C OT, Nursing I/C and other key members of staff
should be constituted.
The scope of work of this QIC will include all the processes involved in the sterilization services being
provided at the camp.
The responsibilities of the QIC will be as follows:
 Identifying critical quality processes in light of the standards for sterilization
 Reviewing the processes with the help of the checklists on client case audit/ facility audit/
 Developing a work plan listing activities for improvement and putting this into action
observation of sepsis and surgical procedure
The QIC should meet once a month to review, analyze and recommend solutions to the problems
experienced in holding FW Camps and assess the quality of care. This is essential for taking remedial
actions for future camps, as camps are to be organized as a regular, fixed day monthly activity at facilities
like CHCs and PHCs where regular weekly services are not being provided.
Annexures
30
Standard Operating Procedures for Sterilization Services in Camps
C. Anaesthesia Drugs
Serial
No.
Drugs
No. Required
Female Sterilization
Male Sterilization
1.
Inj. Diazepam
30 amps
5
2.
Inj. Promethazine
30 amps
5
3.
Inj. Pentazocine
30 amps
5
4.
Inj. Atropine
30 amps
5
5.
Inj. Pethidine
30 amps
-
6.
Inj. Xylocaine 2%
25 vials
15 vials
7.
Inj. Ketamine 50mg/ml*
1 vials
-
8.
Inj. Scoline*
1 vials
-
9.
Inj. Pentothal 1 gm vial*
1 vials
-
(*as per requirement, if anaesthetist is available)
D. Emergency Drugs; *for Both – Tubectomy & Vasectomy Camps
Serial No.
Name
No. Required
1.
Inj. Andrenalin
10 amps
2.
Inj. Hydrocortisone
3.
Inj. Chlorpheneramine Maleate
10 amps
4.
Inj. Frusamide
5 amps
5.
Inj. Atropine
10 amps
6.
Inj. Mephentine
7.
Inj. Aminophylline
5 amps
8.
Inj. Deriphylline
5 amps
9.
Inj. Soda Bicarb.
12 amps
10.
Inj. Diazepam
5 amps
11.
I/V fluids 5% dextrose
5 vacs
12.
Normal Saline
5 vacs
13.
Ringer Lactate
5 vacs
10 vials of 100 ml each
2 vial
* Anaphylaxis trays and emergency trays should be maintained and both trays should be readily available in operation theatre
and injection room
Standard Operating Procedures for Sterilization Services in Camps
E.
Post-Operative Drugs
Serial
No.
Name
No. Required
Tubectomy
Vasectomy
1.
Cap. Amoxycillin-cloxacillin 500 mg
500 capsules
600 capsules
2.
Tab. Ciprofloxacin
500 capsules
600 capsules
3.
Tab. Ibuprofen 400 mgs
500 tablets
600 tablets
4.
Tab. B Complex200 tablets
200 tablets
200 tablets
5.
Tab. Iron
200 tablets
-
F.
Disinfectants/Antiseptics, etc.
Serial
No.
Name
No. Required
Tubectomy
Vasectomy
1.
Gluteraldehyde *
10 litre
5 litre
2.
Povidine Iodine 5%
1.5 litre
1.5 litre
3.
Spirit
2 litre
1 litre
4.
Bleaching Powder 150 gms packets
15 packets
15 packets
5.
Surgical Hand scrub
500 ml
500 ml
6.
Detergent powder
250 gms.
250 gms.
* Should be available with the team, if site does not provide regular sterilization services.
G. Dressing Material
Serial
No.
Name
No. Required
Tubectomy
1.
Medicated tape large size
2.
Adhesive plaster-10 cm wide
3.
Bandages 6”
4.
5.
Vasectomy
50
2 rolls
-
3 dozen
4 dozen
Cotton ½ kg. roll
2
2
Gauze Thin
4
4
31
Annexure 1
Equipment for Male/Female Sterilization
Equipment/instruments and supplies are given for a client load of 30 for one surgical
team
A. Sterilization Equipment for Male/Female Sterilization
Serial
No.
B.
Item
No. Required
Female Sterilization
Male Sterilization
1.
Laprocator/laparoscope sets
3
-
2.
Minilap sets
5
-
3.
NSV Kits
4.
Conventional Vas Kit
-
5.
Voltage stabilizer
1
6.
Falope-rings
7.
8.
5
5
40 pairs
-
CO2 cylinder (if available)
2
-
Insufflators
1
-
Anaesthesia Equipment
Serial No.
Item
No. Required
1.
Portable Boyle’s apparatus*
1
2.
Oxygen cylinders with mask (adult) and wrench
2
3.
Nitrous oxide cylinders*
2
4.
Laryngoscope
1
5.
Ambu bag adult size
1
6.
Endotracheal tubes
1 of each size
* If anaesthetist available
32
Standard Operating Procedures for Sterilization Services in Camps
H. Other Equipment and Articles
Serial
No.
Name
No. Required
Tubectomy
Vasectomy
3
2
2 (metal)
--
1.
Cidex tray
2.
Female Urethral Catheter
3.
Enema cans
2
--
4.
Sponge holding forceps
6
6
5.
Vaginal Speculum (Sims)
3
--
6.
Volsellum
3
--
7.
Sterilized surgical
gloves
6.5 Nos.
7 & 7.5 Nos.
40 pairs
40 pairs
40 pairs
30 pairs
30 pairs
40 pairs
8.
Utility Gloves
7, 8 and 9 Nos.
6 pairs
6 pairs
9.
BP apparatus
3
2
10.
Stethoscope
3
2
11.
Torch 4 cell
1
1
12.
Heat convectors
2
2
13.
Sterilization drums
12
6
14.
Autoclave
2
2
15.
Boilers for HLD
3
2
16.
Steel bowls
6
6
17.
Chittle’s forceps
3
2
18.
Sharp scissors for gauze cutting
1
1
19.
Sterilized Syringes
10 ml
40
20
5 ml
40
20
2 ml
40
5
10 pieces each
10 pieces each *
15 foils
25
20.
Surgical blades No. 11, 15
21.
Catgut chromic 1-0
22.
Silk thread 2-0
2 roll
2 roll
23.
4 burner stove
2
2
24.
Anterior vaginal wall retractor
2
--
25.
Uterine sound
2
--
* If conventional vasectomy done
Contd...
Standard Operating Procedures for Sterilization Services in Camps
Serial
No.
Name
No. Required
Tubectomy
Vasectomy
500 gms
500 gms
26.
Powder for gloves * *
27.
Wash basin
2
2
28.
Kidney trays, stainless steel
3
3
29.
Hypodermic needles numbers 23,24,26
4 dozen each
4 dozen each
30.
I/V Sets
5
5
31.
Scalp vein sets size 21
35
5
32.
Venflon 20G
5
5
33.
Plastic Ccontainers for decontamination
2
2
34.
Plastic tubs for cleaning instruments
2
2
35.
Plastic linen container (for used linen),
with cover
2
2
36.
Waste containers
4
4
37.
Wall clock
1
1
** If autoclaved gloves are used
I.
Linen
Serial
No.
Name
No. Required
Tubectomy
Vasectomy
1.
Surgical Gowns
20
10
2.
Plastic aprons
6
6
3.
Caps
20
10
4.
Masks
20
10
5.
Eye cover / shield *
12
6
6.
Covered plastic shoes
shoe cover
12 pairs
12 pairs
7.
Sterilized surgical sheets (Cut sheets)
40
40
8.
Mackintosh sheet
15 meters
15 meters
9.
Surgeon suits
12
--
10.
Patient suits
30
sizes 8 & 9 or
* If service provider uses own power glasses, then not required, other wise plain glasses/eye shield required
33
Annexure 2
Management of Emergencies in Sterilization
Services
It is essential that when an emergency occurs the doctors, nurses and other staff should respond
competently in order to save the life of the client. Members of the staff must be trained to handle
specific complications. The person monitoring the client in the operating operation room theatre
and in the recovery room must be aware of early signs of complications, and be able to take initial
emergency action. At least one member of the team must know how to administer cardiopulmonary
resuscitation.
Knowing what to do in an emergency requires knowledge of:
t
Clinical situations, their diagnosis and the treatment
t Drugs, their use, administration and side effects
t Emergency equipment and how it functions and
t The role of each team member in an emergency
A. Approach to an Emergency
When some one collapses or becomes suddenly ill:
 Try to keep calm and think logically: you probably do know what to do.
 Make sure that some one with medical knowledge stays with the client
 Call for help. Delegate someone to call other assistants and get the oxygen cylinder, Ambu bag
 Talk to the client; ask questions.
 Stop any procedures that are in progress on the client and
 Proceed with the following -
and emergency drugs.
t
Lower the head of the table
t
Give oxygen
t
Start an IV if not in place
t
Note the time
t
Continue to monitor vital signs
t
Assess the client’s ABC : Airways, Breathing and Circulation
Standard Operating Procedures for Sterilization Services in Camps
B.
35
Assess the Client’s ABCs
Airway:
Is there anything blocking the mouth or throat? Has the tongue fallen back? Try to extend the neck
and pull the jaw forward.
Breathing:
Is the client breathing? Put your cheek down to the client’s mouth to look, listen and feel for the passage
of air.
Circulation:
Check for pulse, preferably carotid. Use 5 seconds to check the pulse in the neck.
C. Cardio-pulmonary Rescuscitation (CPR)
Step A: Airways
1. Open air ways, use head tilt – chin lift position to correct obstruction by tongue.
2. Look, listen and feel for breathing for 3-5 seconds
3. Keep air way open
4. Clear air way by suctioning any secretions or vomitus
Head Tilt – Chin Lift
If client is not breathing, follow Step B
Step B: Breathing
1. Insert oral airway. Insert airway up side down (curved tip pointing to roof of the mouth) and
rotate the air way 180 degrees during insertion until the flange is against teeth.
2. Ventilate patient using either an Ambu bag with 100% oxygen or manual resuscitator with
room air. Place mask over mouth and nose. Apply pressure to keep sealed. Compress bag to
deliver air.
If oral air way cannot be passed, insert a nasopharyngeal air way.
If the above is not available – perform mouth- to- mouth resuscitation.
36
Standard Operating Procedures for Sterilization Services in Camps
3. Give two slow breaths.
t
Maintain head tilt – chin lift position
t
Ensure breaths go in by watching chest rise and by listening for breath sounds with
stethoscope on side of patient’s chest
t
If breaths do not go in, reposition head and try again to give breaths.
t
Allow all air to escape between breaths
t
Avoid overly large volumes of breaths
4. Check carotid pulse. If patient has no pulse, follow Step C.
5. Continue breathing at the rate of 10-12 breaths per minutes until the patient breathes spontaneously. Avoid more rapid breaths.
6. Place Endo-tracheal tube ( if trained and skilled personnel available).
Step C: Circulation
Perform external cardiac compression
(1)
Chest compression technique
1. Place your fingers on the lower margin of the client’s rib cage on the side nearer you (Shown
in Figure).
2. Slide your fingers up the rib cage to the notch where the ribs meet the lower sternum in the
centre of the lower part of the chest.
3. Place the base of one hand on the lower half of the sternum (Shown in Figure) and the other
hand on top of the first, so that the hands are parallel (Shown in Figure).
4. Keep hands in contact with the chest at all times.
5. Compress sternum down 4 to 5 cm. smoothly.
Standard Operating Procedures for Sterilization Services in Camps
37
Position the rescuer’s hand on the lower half of the sternum
A
B
C
D
Two person rescue:
t
Give 5 compressions in approximately 3 seconds
t
Give 1 full breath. After every 5 compressions pause to allow second medical attendant
to give 1 breath. Give breaths as in Step B.
One person rescue:
t
Give 15 compressions in approximately 10 seconds
t
Give 2 full breaths. After every 15 compressions give two breaths. Give breaths as in
Step B.
6. Stop CPR after one minute to determine if the patient has resumed spontaneously breathing
or circulation; otherwise do not stop CPR for more than 5 seconds.
7. Continue CPR until client responds or for a minimum of 30 minutes
8. Apply ECG leads if available. Continue CPR and transfer the patient to a higher centre if
needed.
Annexure 3
Common Emergency Drugs
Drug
Situation
Dose
Precautions/
Comments
Causes drowsiness.
Do not exceed 75
mgs. If anaphylaxis
worsen, give
adrenaline
Pheneramine
Maleate
25 mg tabs
2cc amp25 mg /cc
Allergic reactions With early symptoms
or anaphylactic
(rash, hives, rhinitis)
reaction
give 25 mg orally.
If symptoms of
respiratory difficulty
give 50 mg SC/IM or
IV and follow with
adrenaline
Adrenaline
Epinephrine)
1:1000
- Severe asthma
or
- Anaphylactic
reaction
0.5 mg. SC or IM
(Massage injection
site). May repeat
every 10 minutes until
symptoms improve
1:1000 is not the
concentration for IV
use. 1:1000 must be
diluted in 10-20 cc IV
fluids to give by IV
route. If symptoms
progress give
Dexamethasone
- Cardiac arrest
or no pulse
- no breathing
0.5 mg of 1: 1000
diluted in 10 – 20 ml
IV fluids or 0.5 mg
of 1: 10000 IV. May
repeat every 3 minutes
Do not give
adrenaline 1:1000 IV
undiluted or quickly.
Adrenaline will
precipitate if mixed
with other IV drugs
Vaso-vagal
reaction /
syncope
(fainting)
0.6 mg /ml
Side effects of
dry mouth and
tachycardia (fast heart
rate)
Atropine
0.6 mg/ml
I cc Vial
Effects
Allergic reactions and
anaphylaxis: It is antihistaminic and
will reduce the rash, hives, itching,
congestion and inflammation caused
by the allergic reaction (histamine
release). It is the first drug given
when allergic symptoms are
observed.
- Asthma and anaphylaxis:
Adrenaline produces
bronchodilation, which relieves
breathing difficulties during
bronchospasm. In small doses
adrenaline causes vaso dilation
which can correct lung constriction
and wheezing. Giving adrenaline
during an anaphylactic reaction or
acute asthma may save the client’s
life.
- Anaphylactic Shock: In large
doses, adrenaline is a vasoconstrictor that will raise blood
pressure and pulse rate. Thus
adrenaline is a life saving drug in
anaphylactic shock.
- Cardiac arrest: Adrenaline
produces cardiac and central
nervous system stimulation. When
there is no breathing and no or faint
pulse, giving adrenaline is to attempt
to stimulate the heart to begin
beating again.
- Vaso-vagal syncope (fainting
from severe fear or pain):
Atropine increases the heart rate and
cardiac output.
Contd...
Standard Operating Procedures for Sterilization Services in Camps
Drug
Situation
Cardiac arrest
Dose
0.6 mg/ml
DexaAnaphylaxis or
methasone
severe asthma
vial – 4mg / cc
8 mg IV
Diazepam
Seizure
2cc vial – 5 mg
/cc
5 mg IV may be
repeated every 10
minutes to maximum
of 20 mg.
Naloxone
1cc vial - 5
mg/1cc
0.4 mg SC/IM/IV
and may be repeated
every 2 minutes to
maximum of 10 mg
Narcotic drug
overdose
Promethazine Nausea and
2cc vial – 25
vomiting
mg/cc
25 mg IM/IV/PO
Precautions/
Comments
I mg IV may be
repeated every 5
minutes to total of
3 mg
39
Effects
Atropine is effective in faintness
after/during a procedure (minilap,
IUD insertion)
- Cardiac arrest: Atropine increases
heart rate of pumping and may
correct dysrythmias caused by a
slow heart rate.
- Pre surgery: Atropine is used as
a premedication for surgery, as it
decreases secretions ( respiratory
and GI tracts) and may prevent a
slow heart rate (bradycardia) which
is the side effect of some pain
medications (Pentazocine) used
during tubectomy.
Hydrocortisone 200
- Anaphylaxis or severe asthma:
mg if Dexamethasone During an asthma attack or severe
is not available
allergic reaction the body reacts
with inflammation/swelling.
Dexamethasone and hydrocortisone
are corticosteroids that decrease
inflammation and increase the
capillary permeability. In asthma
or anaphylactic reaction, a steroid
will ease the breathing difficulties.
Steroids also are used in cerebral
oedema and septic shock
Give slowly over
- Seizure: Diazepam causes skeletal
2 minutes. Side
muscle to relax and is used to stop
effect of respiratory
status-epileptics and/or titanic
depression
muscle spasm.
- Pre-surgery: Reduces feeling of
anxiety and helps clients be calm
and co-operative during pain/fear
producing procedures
Reverses respiratory
- Opiate overdose: Naloxone
depression from
reverses the effect of narcotics
narcotic medications. (pethidine, Pentazocine, morphine
etc.) in the case of a narcotic
overdose. Naloxone will reverse
respiratory depression and thus is a
life saving drug
- Nausea/vomiting: Promethazine
is an antihistamine that produces
sedation and reduces nausea.
Vomiting in a sedated patient
has potential risk of aspiration.
Promethazine is also used as an
adjunct drug to prevent nausea
from pre-surgical medications
(Pentazocine)
List of Experts for Formulating the Standard
Operating Procedures on Family Planning Services
1.
Dr. B.P. Singh
Senior Training Manager
Engender Health
Sarvapriya Vihar
New Delhi – 110 016
Mobile - 9412704877
2.
Dr. G.N. Sahoo
State NSV Trainer and Joint Director
Bokaro General Hospital
Bokaro Steel City
Jharkhand – 827004
Mobile: 09431191950
Email: [email protected]
3.
Dr. R.C.M Kaza
Professor of Surgery
Maulana Azad Medical College
Bahadur Shah Safar Marg
New Delhi – 110 002
Telephone: 2821314
Mobile: 9812210987
4.
Dr. D. K. Mangal
Technical Advisor (HIV/AIDS)
United Nations Population Fund
53 Jorbagh
New Delhi – 110 003
Mobile: 09810783023
Email: [email protected]
5.
Dr. Alok Banerjee
Senior Medical Consultant
Parivar Sewa Sanstha
C-374, Defence Colony
New Delhi – 110 024
Telephone: 24337712
Mobile: 9810503707
6.
Dr. Usha Sharma
Professor of Gynaecology & Obstetrics
Lala Lajpat Rai Memorial Medical College
Meerut – 250004
Telephone: 0121-2760555
Mobile: 09837020407
Email: [email protected]
7.
Dr. Girija
Gynecologist
General Hospital
Ernakulum
Kerala – 682010
Telephone: 0484-2312683
Mobile: 098952-12683
8.
Dr. Anoop Raj Gogia
Professor
Department of Anaesthesia
Safdarjung Hospital
New Delhi
Telephone: 26198462
Mobile: 9810318291
9.
Dr. Chakrapani
Anaesthetist
General Hospital
Arasikere
Hassan District
Karnataka
Telephone: 08174-232472
Mobile: 09844423346
10.
Dr. Girish
Anaesthetist
PHC - Vijapura
Chitradurga District
Karnataka
Email: [email protected]
11.
Dr. Baasav Raj
General Surgeon
District Hospital
Chitradurga District
Karnataka
Telephone: 08194-230986
Mobile: 9342312486
12.
Dr. M.L.N. Reddy
State NSV Trainer
HQ Hospital
District Karimnagar
Andhra Pradesh
Mobile: 09849902499
Standard Operating Procedures for Sterilization Services in Camps
13.
Dr. Dinesh Kumar
Anaesthetist
Mehboobnagar District
Andhra Pradesh
Telephone: 040-2553678
Mobile: 09848274893
14.
Dr. Vijayalakshmi, MD, DGO
DPL Surgeon
Government Medical College
Anathapur
Andhra Pradesh
Mobile: 09848048220
15.
Dr. Trivedi
Gynaecologist
Lady Harding Hospital,
New Delhi
Telephone: 2340829796
Mobile: 9810517477
16.
Dr. Manoranjan Jha
Senior Medical Officer and
State NSV Trainer
Regional Office for
Health & Family Welfare
Government of India
5th Floor, Indira Bhavan
Patna
Telephone: 0612-2320645
Mobile: 09431039496
Email: [email protected]
17.
Dr. L.M. Pant
State NSV trainer
Polyclinic
Malhargang
Indore
Madhya Pradesh
Telephone: 0751-2454560/2701770
Mobile: 09425073594
Email: [email protected]
18.
Dr. R.P. Sharma
State NSV Coordinator
NSV Resource Centre
SIHMC Building,
Gwalior
Mobile: 09827075862
Email: doct.sharma@ hotmail.com
19.
Dr. Syed Iqbal Hussain
Training Coordinator
RCH Directorate
Ranchi
Jharkhand
Mobile: 09431929418
Email: [email protected]
20.
Dr. Sonia Trikha
National Consultant
India Country Office
World Health Organisation (WHO)
Nirman Bhavan
New Delhi – 110 011
Telephone: 01123061955
Email: [email protected]
21.
Dr. Baljit Kaur
State NSV Trainer
Urban Family Welfare Bureau
Sakatri Bagh
Amritsar
Mobile: 0935600963
Email: [email protected]
22.
Dr. M.S. Ranawat
Consultant (Family Welfare)
Block No.5, Old Sachiwayalaya
2nd Floor
Gandhinagar
Gujarat
Mobile: 09427335474
23.
Dr. Arvind Mathur
Cluster Focal Point,
India Country Office
World Health Organisation (WHO)
Nirman Bhavan
New Delhi – 110 011
Telephone: 01123061955
Email: [email protected]
24.
Dr. Jaya Lalmohan
Consultant
Government of India
Ministry of Health & Family Welfare
Nirman Bhawan
New Delhi – 110 011
Mobile: 9312989559
Email: [email protected]
41
42
Standard Operating Procedures for Sterilization Services in Camps
25.
Dr. Sonali
Consultant
Government of India
Ministry of Health & Family Welfare
Nirman Bhawan
New Delhi – 110 011
Email: [email protected]
26.
Dr. M. S. Jayalakshmi
Deputy Commissioner
Government of India
Ministry of Health & Family Welfare
Nirman Bhawan
New Delhi – 110 011
Telephone: 23062485
Mobile: 9810372267
Email: [email protected]
27.
Dr. S. K. Sikdar
Assistant Commissioner
Government of India
Ministry of Health & Family Welfare
Nirman Bhawan
New Delhi – 110 011
Telephone: 23062427
Mobile: 09911422499
Email: [email protected]
Notes
Notes
Notes
Notes